Teacher Evaluation System - Polk County School District

ARROW for District Professional Learning Activity:
ACCOUNTABILITY REPORT: REFLECTIONS AND OUTCOMES OF WORK
Last Name First Name Middle Soc. Sec. # SAP ID #
Professional Learning Activity
Date(s)
Date Follow Up Due:
Rationale (check all that apply, but at least one) Primary State Focus Area
Related to my TARGET (Ind. Prof. Learn. Plan)
Review-Disaggregated Student Achievement Data
Based on SIP Goals
Related To District Strategic Plan Action Plan
PDP Requirement
Specified District-Wide Initiative
Certification Needs
Professional Growth Interests
Assessment Data Analysis
Sunshine State Standards
Teaching Methods
Classroom Management
Leadership/ Management
Technology
School Safety
Parental Involvement
Shared Assessment Feedback From Administrator
Specific Initiative- Grade Level/Subject
Other
Specify:
***THIS SECTION IS TO BE COMPLETED ONLY BY PARTICIPANT! As a result of gains in my knowledge and skill from this professional learning experience,
I have applied varied principles, concepts, or skills related to its content, in the following way(s) in order to improve student achievement:
***THIS SECTION IS TO BE COMPLETED ONLY BY PARTICIPANT!
The degree to which my participation in this professional learning activity has had a positive impact on the achievement of my students (i.e., Learning Gains) is best described as…
Very Significantly Significantly Uncertain Minimally No Impact Evaluated
Professional Learning Mechanisms: (check all that apply, but at least one)
Action Research Project Lesson Study Group Peer Coaching School Coaching Professional Learning Community
PD 360 or other Web-Based Learning Independent Study Workshop Other Specify:
Related Follow-Up Process Applied (check all that apply, but at least one)
Collaborative Planning related to professional learning Study Group participation
Participant Product related to professional learning
Electronic Interactive (i.e.: Blackboard, FORPD)
(i.e.: lesson plans, written reflection, audio/video recording, case study, student work samples, etc.)
Action Research related to professional learning (Should include evidence of implementation) Electronic Non-Interactive
Follow-Up Verified By:
Name:
Signature:
Title:
Date:
District Professional Learning Activity Points Documentation:
District Professional Learning Facilitator: Department:
Facilitator’s Signature: MIP Component #:
Possible Participation Points: Possible Follow Up Points: Total Points Possible:
Participation Points Earned: Follow Up Points Earned: Total Points Earned:
Participant’s Signature: ________________________________ Date: ______________ *Copy placed in Participant’s School File (original sent to District facilitator with follow-up)
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